MEDICARE: MS. THERESA ANN PACE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922269463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. THERESA ANN PACE

Provider Business Mailing Address
First Line	:	PO BOX 261844
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33685-1844
Country	:	US
Telephone Number	:	813-610-1562
Fax Number	:	813-884-8898

Provider Business Practice Location Address
First Line	:	9056 HICKORY CIR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-1441
Country	:	US
Telephone Number	:	813-610-1562
Fax Number	:	813-884-8898

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2008
Last Update Date	:	06/18/2008

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